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Shadows and Light

Nights are the worst. I toss and turn, seeking a blessed relief from consciousness that seems to come only at dawn. Sometimes an intense grief overwhelms me and I want to die. How do other people get through the night?

Daytime brings its own kind of pain. I either drift through the day in numbness, unable to bear the pain, or I succumb to spasms of tears, terrors, or a vast sense of inner chaos. My life is fragmented, so fragile that each tremor of emotion threatens my existence.

Six years ago, I was diagnosed with recurrent major depression. I have been hospitalized twice for suicidal impulses and have been through seven therapists since the age of 12. I have felt depressed for the last 30 years-in fact, I just assumed everyone felt this way and simply handled it better than I did. I was sure that I was fundamentally flawed as a person.

FIVE YEARS AGO, I began using Prozac. It changed my life, and medication continues to change my life-when it works. When it stops working, I'm back to square one.

Prozac opened a door into a life I thought would forever be denied me-normalcy. I could function at work, be more relaxed around others, even picture a future without suicide or insanity as the inevitable destination. It seems hard to believe that a little green and yellow pill (featured on the cover of Time magazine!) could do so much.

For many people, six months or so on medications triggers something in their biology and they can discontinue Prozac-a financial relief, if nothing else, because each pill costs around $1.80. I have watched friend after friend go on Prozac, feel stability return, and then go off. But there are others, like myself, who discover how much of an art it is to prescribe the right combination of anti-depressant medication for a particular individual.

My treatment began with 20 mg. of Prozac a day-wow, what a change! But, now the insomnia gets really bad, so add on 50 mg. of trazodone (another anti-depressant). This works for a while and then suddenly, without warning, I just can't get through the day. Doubling the Prozac helps, but now the trazodone needs doubling too so I can sleep at night. Everything runs smoothly again and then crash! 600 mg. of lithium is added to all of the above. (Did I mention that there is a fine line between the therapeutic and toxic levels of lithium?) Whoops-another crash inevitably comes and now I am taking 60 mg. of Prozac, 600 mg. of lithium, and 150 mg. of trazodone on a daily basis. Eventually my doctor becomes frustrated and pulls me off everything to try something new on the market (Wellbutrin, Effexor, Paxil...you get my drift).

Did I mention the side effects from the medication? They have included: dry mouth, insomnia, constipation, hemorrhoids, decreased appetite, increased appetite, blurred vision, vertigo, sexual dysfunction, tremors, and irregular periods and spotting. Each new medication brings its own unique discomfort to my life.

I'm not really complaining. Even with the cost and side effects, my life is much better on medication than off.

What does push my buttons is Prozac's high profile in our culture. I hear references and/or jokes about it by Jay Leno, a sportscaster on the evening news, MAD TV, Woody Allen movies, bestselling books (Prozac Nation, Listening to Prozac, Living With Prozac), and news magazines.

For a while now, the media have run with the idea of Prozac leading to suicide and/or violent outbursts. I've come to dread reading the words, "The gunman was on Prozac at the time of the shootings." Why don't they write that the gunman was on Elavil or Sinequan? Even Twinkies are mentioned in the news more often as a possible cause of violent behavior than these lesser known anti-depressants.

My buttons are much less sensitive since my doctor put me on a combination of Paxil and Mellaril (I don't hear any comments by Leno on either of these!). Therapy continues to be an important part of treating my depression. But medication is a fact of life for me in the indefinite future. It allows me to feel the same highs and lows any normal person would feel. And that is what I want to be.

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